A Clinical Analysis Of Aortography And Local Electrophysiological Characteristics Of The Aortic Sinus Cusps

[Objective] To discuss the clinical application of aortography and local electrophysiological characteristics at aortic sinus cusps (ASC), and to guide catheter ablation tachycardia originating from the aortic sinus cusp in patients.[Methods] In40patients with tachyarrhythmia undergoing radiofrequency catheter ablation (RFCA) through aortic retrograde approach, including7patients with premature ventricular contractions or ventricular tachycardia (PVCs/VT) and33patients with atrioventricular reentrant tachycardia(AVRT),the amplitudes of the atrial (A) and ventricular (V) potentials during sinus rhythm were measured at left coronary cusp(LCC), right coronary cusp (RCC) and noncoronary cusp (NCC), the amplitude ratio of atrial/ventricular (A/V) potential was also measured. According the aortographic images and local electrophysiological characteristics to analysis relative positions of the coronary cusps. [Results]1. The mean amplitudes of the atrial potential were in descending order of NCC (0.62±0.24)mV>LCC(0.28±.16)mV>RCC (0.09±0.04)mV (P<0.01). In contrast to the atrial potential, the mean amplitudes of the ventricular potential descended in the opposite order of RCC (1.01±0.52)mV> LCC (0.67±0.27)mV> NCC (0.15±0.13)mV (P<0.01).2. For all patients, the amplitudes of the atrial potential were smaller than those of the ventricular potential in the left coronary cusps and right coronary cusps, resulting in the A/V ratio<1(0.41±0.15,0.10±0.07, respectively). The amplitude of the atrial potential was larger than the ventricular potential in the noncoronary cusps, resulting in A/V ratio>1(5.13±2.56).The A/V ratio of the noncoronary cusps were significantly greater than those of other two aortic sinus cusps (P<0.0001).3. The his bundle potentials were recorded at the noncoronary cusps (7patients;17.5%) and the right coronary cusps (9patients;22.5%).4. Aortography depicted the upper left-side aspect of the LCC, the right-side aspect of the RCC, and the inferior aspect of the NCC in the LAO45°projection, and the superior aspect of the left coronary cusp, the anterior aspect of the right coronary cusps, and inferoposterior aspect of the noncoronary cusps in the RAO30°projection.[Conclusion]In the process of RFCA and mapping suitable targets at the aortic sinus cusps, the aortographic images and electrophysiological characteristics have orientating function, and make it more accurate,safer and effective catheter ablation at the aortic sinus cusps.